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Hand-stitching or Stapling for Tummy Tuck Incision?

I have been contemplating a Tummy Tuck for several years now, and have viewed hundreds of photos. I've seen some incredibly even, thin scars and some horrific wide, jagged scars. My sister (a nurse) said a lot (I did not understand everything) of this is attributable to whether the the incision was hand-stitched or stapled. She said hand-stitching allows a much neater, tighter scar than stapling, which creates inevitable gaps that don't heal as neatly. She also mentioned the time factor involved in hand stitching.

That led me to wonder whether hand-stitching is the exception or the rule. Any thoughts?

Doctor Answers (10)

Never Use Staples to Close a Tummy Tuck Incision

+5

Thank you for your question. Your sister is correct. Staple leave an extra external scar around the Tummy Tuck incision on either side where the staples puncture the skin.

Most plastic surgeons use internal stitches called a "Running Intracuticular" to avoid external suture marks.

As pointed out below there are many factors involved in Tummy Tuck scar, but a closure with staples should be avoided.


Boston Plastic Surgeon
4.5 out of 5 stars 30 reviews

Do staples or stitches give better scar after tummy tuck?

+2

In general, hand-sewing the skin will result in a better tummy tuck scar than stapling. There are a number of other factors that influence the ultimate appearance of a tummy tuck scar, including the placement of the incision, how much tension is on the skin (pulling in either direction), how many layers of stitches there are, the quality of the skin, and genetic and nutritional factors. A wide scar can occur with either type of closure. Staples can also leave "track marks" or little scars along the staple lines that can be temporary or permanent. [Just FYI, there are also absorbable staples that can be used for repairing the deep portion of the skin, which are placed below the skin surface and take the place of one layer of stitches.] In practice, I prefer to close my tummy tucks incisions in 3 hand-sewn layers, and have found this to leave an optimal scar. After surgery I like to monitor the healing and take steps to optimize the scar even further, such as silicone scar gel, silicone sheeting, or steroid injections if there is a raised scar. As you can see, the preoperative planning, intraoperative technique, and postoperative followup are all important factors influencing your ultimate scar, in addition to your own healing characteristics.

Anita Patel, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 11 reviews

Sututring Better For Tummy Tuck Scars

+1
When it comes to cosmetic surgery, the purpose of any procedure is to enhance your appearance. You want to look better, and this relies on a surgeon who applies safe surgical techniques that are optimized to achieve the best aesthetic result possible. With this in mind, I never use staples during the tummy tuck procedure.

Some surgeons use staples to close incisions made during a tummy tuck because it is faster to staple your skin together than apply sutures. Unfortunately, while your actual surgery time may be shorter, you'll be left with a less than ideal result. Your scarring will be uneven and more visible—kind of like train tracks with extra puncture holes on either side of the incision line where the staples enter the skin. Plus, you'll have to schedule yet another appointment in a week or so to get your staples removed. Your sister is right!

Several studies suggest that there is a higher chance you'll experience significantly more pain when your incisions are closed with staples rather than sutures.

As a matter of fact, even stitches can leave more apparent marks if they are left in the skin for too long. That's why I use an "invisible suture technique" for the long tummy tuck incision. Not only is all the suturing internal, there are no visible sutures and all are absorbable, which means no sutures need to be removed.

If scarring is a concern for your tummy tuck, surgeons agree that sutures achieve a superior aesthetic result than staples. Sutures take longer to apply, but it's worth your surgeon's extra effort.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 57 reviews

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Stitches versus staples

+1

I always suture the abdominoplasty wound.  It takes longer to do this but achieves a far better result in terms of the scar.  If you are paying for the procedure, you deserve the optimal scar that the surgeon has the expertise to provide.  Understand that some surgeons cut corners and others do not.  That is why it is important for you to actively participate in your care and inquire about the method of closure that the surgeon intends to use.

 

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 11 reviews

Tummy tuck scars

+1

There are many factors contribute to the final appearance of a scar after tummy tuck. For  example,  some patients are prone to develop keloid or hypertrophic scars despite the surgeon's  best efforts.  Some patients will develop superficial separations of the incision line, depending on the quality of the skin present (for example, stretched marked skin may not “hold” sutures as well as skin with normal thickness dermis).

On  the other hand, the surgeon may be able to control  the quality of the scar  with attention to certain  technical details. For example,  it is important to take as much tension off the final layer of closure as possible-  if tension is taken off the superficial layer (by using deep sutures)  the incision may heal with a finer line scar. Avoiding excessive excision of skin may also help avoid tension upon closure of the suture line.

The use of silicone-based products (creams or  sheeting)  may also be helpful in achieving the best scars  possible.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 718 reviews

No staples for tummy tuck

+1

I do not know of a single cosmetic plastic surgeon who uses staples to close a tummy tuck incision. The vast majority of surgeons use a subcuticular skin closure which does not need to be removed and is hidden completely under the surface so that no cross hatching scars result that may occur with skin staples. The suture can be left for long periods of time and absorbs by itself. Skin staples may be faster and save time but usually will not produce as good a scar.  Always remember that everyone heals differently and some people obtain thinner and flatter less noticeable scars than others despite the technique of the surgeon. Tummy Tuck scars may take up to 18 months to fully mature.

Richard Linderman, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 7 reviews

Both

+1

I have been exclusively using a special suture, called barbed suture, which locks the tissues without tieing knots. On the epidermis, superficial layer of skin, i use staples and remove them in day 3-4, and use tape. staples are much less destructive to skin, since they approximate the skin, and not cut like suture needle does. If you remove the staples early enough, will not leave any marks. Promise.

Adil Ceydeli, MD
Panama City Plastic Surgeon
5.0 out of 5 stars 44 reviews

Sutures better than staples for tummy tuck

+1

Staple closure is very rare in plastic surgery except in certain situation. Tummy tuck incisions are better sutured rather than stapled.

The way scars could heal is related to many factors and the way the incision is sutured is only one of them. Genetics does play a major role in scarring. We all scar in different ways! Hope that helps.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 6 reviews

I would not recommend staples for tummy tuck surgery.

+1

I agree that closure of a tummy tuck should be a hand sewn meticulous closure with subcuticular sutures. This ensures that there will be no "track marks" to the permanent scar which is an unacceptable result for an elective cosmetic procedure. You should ask to see your prospective plastic surgeon's pictures of before and after pictures to see what type of final result to expect.

David Rankin, MD
Fort Lauderdale Plastic Surgeon
4.5 out of 5 stars 50 reviews

The scar quality is always worse with external staples

+1

Despite the fact that any patient can develop an unfavorable scar even in the best of hands, it is pretty clear that external staples will generally leave a much worse scar.

Definitely give stronger consideration to any plastic surgeon who tells you they'll use sutures alone to close the tummy tuck wound.

Yes, it is much more time consuming and results in more expense to the facility, but the time and costs of suturing the wound together is worth it when it comes to the ultimate and final appearance of the scar.

Good luck. The results from a tummy tuck can be amazing!

Brian K. Brzowski, MD
Ogden Plastic Surgeon
5.0 out of 5 stars 19 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.